Pharmacy Services

pharmacy searchable CenCal Health Pharmacy Services provides a comprehensive pharmacy benefit that includes formulary management, a robust pharmacy network, and quality customer service. Our pharmacy network spans both Santa Barbara and San Luis Obispo Counties providing our members with convenient pharmacy locations.

Pharmacy Benefit Manager

CenCal Health has contracted with MedImpact as its Pharmacy Benefit Manager (PBM) to assist in the administration of our pharmacy benefit.

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MedImpact provides: 

  • Claims processing
  • Pharmacy network management
  • Prior authorizations
  • Customer service
  • Drug utilization management services

CenCal Health Pharmacy Team shall oversee MedImpact’s administrative and daily operational role. To contact MedImpact, call: (800) 788-2949.

Our Promise: Our Pharmacy Team is committed to providing consistent, compassionate, local support.

2019-2020 Flu & RSV Season

Prepare for 2019-2020 Flu Season

The Flu Season is now upon us. The Pharmacy Flu Program can help your patients stay healthy this flu season. As part of the pharmacy benefits provided by CenCal Health and MedImpact, our members are eligible to receive the flu vaccine directly from a participating pharmacy in our network. CenCal Health members may choose from a variety of participating pharmacy locations including drug stores, supermarkets, retailers and independent pharmacies. Members may contact their local pharmacy for vaccination hours and appointment requirements. If providers choose to administer the flu vaccine in their office, they can bill CenCal Health. 

If you have questions regarding the Pharmacy Flu Program, please contact the CenCal Health Pharmacy Services Department at (800) 421-2560 ext. 1080.

Synagis® Pharmacy Update: RSV Season

CenCal Health would like to assist our members and providers in preparation for the upcoming RSV season. In conjunction with the Department of Health Care Services' Children's Medical Services Network, the Synagis® prophylaxis season will begin November 1, 2019, and run through March 31, 2020. Medical Request Forms (MRFs) will be accepted beginning October 1st for initial administration beginning November 1st to ensure that the infant's/child's weight is current. 

Synagis® is required to be ordered through our Specialty Pharmacy vendor, Diplomat Specialty Pharmacy. Order forms may be obtained here, or by contacting Diplomat Specialty Pharmacy directly at (877) 319-6337. Please contact CenCal Health Pharmacy Services Department at (805) 562-1080 with any questions. 

Opioid Updates 2019

Opioid and Benzodiazepine Concomitant Use Safety Edit

With the approval of CenCal Health's Pharmacy and Therapeutics Committee and in coordination with its Pharmacy Benefits Manager (MedImpact), CenCal Health continues to implement a multi-phase plan to deter over-utilization of opioids, and update utilization management measures.

Effective 9/1/2019, CenCal Health will implement an opioid and benzodiazepine concomitant use safety edit. The safety edit is a point of sale (POS) intervention that will identify and deny concurrent use of opioids and benzodiazepines when there is any overlap in the day supply. Interventions will work bi-directionally and stop claims when there is an opioid-benzodiazepine claim overlap or vice versa. 

In order to override these rejections, the pharmacist may conduct a Drug Utilization Review (DUR) and submit the applicable override that outlines the specific actions taken by the pharmacist. The dispensing pharmacist can bypass the soft edit by using the following overrides: 

4C (Hospice) 1A (Filled As Is, False Positive)
4B (Palliative Care) 1B (Filled As Is, Not Relevant) 
4D (Cancer)  4A (Prescribed with Acknowledgements)
1G (Prescriber Approval) 3G (Drug Therapy Unchanged)

During the month of August, benzodiazepine prescribers who hit the edit described above will receive an outreach letter. The letter will provide the prescriber with a list of their CenCal Health members who are currently taking an opioid and benzodiazepine. Resources around the use of benzodiazepines will be provided in the letter, including the option for a personalized consultation to discuss custom tapering recommendations or alternative treatment choices. Additional pain management resources are also available through CenCal Health on the Pharmacy Pain Management Resources page. 

If you have questions or need additional information, please contact the CenCal Health Pharmacy Department at (805) 562-1080.

2019 Formulary Updates